TRICARE
Encyclopedia
TRICARE, formerly known as the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS), is a health care program of the United States Department of Defense
Military Health System
. TRICARE provides civilian health benefits for military personnel
, military retirees, and their dependents, including some members of the Reserve Component. The TRICARE program is managed by TRICARE Management Activity (TMA) under the authority of the Assistant Secretary of Defense (Health Affairs). TRICARE is the civilian care component of the Military Health System, although historically it also included health care delivered in the military medical treatment facilities.
for military personnel and their dependents was provided in military medical facilities on a "space-available" basis. After World War II
and the Korean War
, access to care in military facilities became increasingly unavailable due to resource constraints and growing demands on the system. To address this problem, Congress
passed the Dependents Medical Care Act of 1956 and the Military Medical Benefits Amendments of 1966. These acts allowed the Secretary of Defense
to contract with civilian health care provider
s. This civilian health care program became known as the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) in 1966.
In the late 1980s, because of escalating costs, paperwork demands, and general beneficiary dissatisfaction, DoD initiated a series of demonstration projects. Under a program known as the CHAMPUS Reform Initiative (CRI), a contractor provided both health care and administrative-related services, including claims processing. The CRI project was one of the first to introduce managed care features to the CHAMPUS program. Beneficiaries under CRI were offered three choices — a health maintenance organization-like option called CHAMPUS Prime that required enrollment and offered enhanced benefits and low-cost shares, a preferred provider organization-like option called CHAMPUS Extra that required use of network providers in exchange for lower cost shares, and the standard CHAMPUS option that continued the freedom of choice in selecting providers but required higher cost shares and deductibles.
Although DOD’s initial intent under CRI was to award three competitively bid contracts covering six states, only one bid, made by Foundation Health Corporation (now Health Net
) covering California
and Hawaii
, was received. Foundation delivered services under this contract between August 1988 and January 1994.
In late 1993, in response to requirements in the DOD Appropriation Act for Fiscal Year 1994, the DoD announced plans for implementing a nationwide managed care program for the MHS that would be completely implemented by May 1997. Under this program, known as TRICARE, the United States
was divided into 12 health care regions. An administrative organization, the lead agent, was designated for each region and coordinated the health care needs of all military treatment facilities in the region. Under TRICARE, seven managed care support contracts were awarded covering DOD’s 12 health care regions.
Since then, TRICARE has undergone several restructuring initiatives, including re-alignment of contract regions, Base Realignment and Closure
, and the addition of "TRICARE for Life" benefits in 2001 for those who are Medicare
-eligible, and "TRICARE Reserve Select" in 2005.
that is payable under TRICARE regulations. The beneficiary is responsible for payment of an annual deductible
and coinsurance
, and may be responsible for certain other out-of-pocket expenses
. There is no enrollment fee for TRICARE Standard.
(PPO). When using TRICARE Extra, the beneficiary's coinsurance amount is reduced by at least five percentage points. There is no fee for use of the TRICARE Extra benefit other than the coinsurance.
(HMO) style plan available to active duty personnel, retirees from the Active Component, retirees from the Reserve Component age 60 or older, and their eligible family members. Under TRICARE Prime, beneficiaries must choose a primary care physician
and obtain referrals and authorizations for specialty care. In return for these restrictions, beneficiaries are responsible only for small copayment
s for each visit. There is an annual enrollment fee for TRICARE Prime for military retirees and their family members. There is no enrollment fee for active duty military and their family members.
, a TRICARE Prime-sponsored health plan option, is made available by nonprofit health care providers in the Northeast U.S., Southeast Texas/Southwest Louisiana, and the Puget Sound region of Washington state.
, Navy Reserve
, Air Force Reserve
, Marine Corps Reserve
), Title 14 USC Federal Reserve Component (Coast Guard Reserve
) and the Title 32 National Guard (Army National Guard
and Air National Guard
) in a drill pay (also known as "paid") status. As of February 2008, retired Reserve Component personnel under the age of 60, actively drilling Individual Ready Reserve
(IRR) personnel in a non-paid status, or actively drilling Volunteer Training Unit (VTU) personnel in a non-paid status do not qualify for TRS. IRR and VTU members are eligible for reinstatement under TRS is they return to a SELRES status. Reserve Component personnel who are also Federal civil servants (to include Army Reserve Technicians and Air Reserve Technicians (ART) in the Army Reserve, Army National Guard, Air Force Reserve and Air National Guard) and eligible for the Federal Employee Health Benefit Program (FEHBP) are also excluded from TRS. Retired Reserve Component personnel and eligible dependent family members become eligible TRICARE Standard, TRICARE Extra or TRICARE Prime on the service member's 60th birthday in the same manner as Active Component retirees and their eligible dependensts are eligible immediately upon retirement from active service. Qualification questions should be referred to TRICARE.
facility where Medicare does not pay. TFL does not pay patient liability for services that are not a TRICARE benefit even though they may be paid by Medicare, such as chiropractic benefits. The policy limitations applying to TRICARE also apply to TFL and must therefore be deemed medically necessary and skilled care. Custodial care therefore is not covered. In 2004 the TRICARE for Life benefit was transferred from the individual regional TRICARE contractors. Medical claims are processed by the national TRICARE Dual Eligible Fiscal Intermediary Contractor (TDEFIC-Wisconsin Physicians Service Insurance Corporation). Pharmacy claims are processed by the TRICARE Pharmacy Contractor (Express Scripts) and Overseas TFL claims are processed by the TRICARE Overseas Program Contractor (as of September 2010 this will be International SOS using Wisconsin Physicians Service as their Fiscal Intermediary partner).
Eligible dependents have the option to purchase TRICARE Standard/Extra health coverage on a month-to-month basis. Purchased coverage includes medical and pharmacy benefits but does not include dental. A premium-based TRICARE Prime benefit will be available later in 2011.
The signing of the National Defense Authorization Act in January 2011 aligned TRICARE with the provisions of the 2010 Patient Protection and Affordable Care Act, and lead to the creation of TYA.New TRICARE Program Offers Coverage for Young Adults Under 26
Enrollment began May 1, 2011.
, and TRICARE Retiree Dental Program (TRDP), run by Delta Dental
.
, TRICARE South
, and TRICARE West
. Services in these regions are provided by:
All medical claims are processed by the following claims processing sub-contractors:
In 2009, the TRICARE Overseas Program contract consolidated the following:
United States Department of Defense
The United States Department of Defense is the U.S...
Military Health System
Military Health System
The Military Health System is the enterprise within the United States Department of Defense responsible for providing health care to active duty and retired U.S. Military personnel and their dependents...
. TRICARE provides civilian health benefits for military personnel
Military personnel
Military personnel is a blanket term used to refer to members of any armed force. Usually, military personnel are divided into branches of service roughly defined by certain circumstances of the deployment of the personnel. Those who serve in a typical large land force are soldiers, making up an...
, military retirees, and their dependents, including some members of the Reserve Component. The TRICARE program is managed by TRICARE Management Activity (TMA) under the authority of the Assistant Secretary of Defense (Health Affairs). TRICARE is the civilian care component of the Military Health System, although historically it also included health care delivered in the military medical treatment facilities.
History
Historically, health careHealth care
Health care is the diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments in humans. Health care is delivered by practitioners in medicine, chiropractic, dentistry, nursing, pharmacy, allied health, and other care providers...
for military personnel and their dependents was provided in military medical facilities on a "space-available" basis. After World War II
World War II
World War II, or the Second World War , was a global conflict lasting from 1939 to 1945, involving most of the world's nations—including all of the great powers—eventually forming two opposing military alliances: the Allies and the Axis...
and the Korean War
Korean War
The Korean War was a conventional war between South Korea, supported by the United Nations, and North Korea, supported by the People's Republic of China , with military material aid from the Soviet Union...
, access to care in military facilities became increasingly unavailable due to resource constraints and growing demands on the system. To address this problem, Congress
United States Congress
The United States Congress is the bicameral legislature of the federal government of the United States, consisting of the Senate and the House of Representatives. The Congress meets in the United States Capitol in Washington, D.C....
passed the Dependents Medical Care Act of 1956 and the Military Medical Benefits Amendments of 1966. These acts allowed the Secretary of Defense
United States Secretary of Defense
The Secretary of Defense is the head and chief executive officer of the Department of Defense of the United States of America. This position corresponds to what is generally known as a Defense Minister in other countries...
to contract with civilian health care provider
Health care provider
A health care provider is an individual or an institution that provides preventive, curative, promotional or rehabilitative health care services in a systematic way to individuals, families or communities....
s. This civilian health care program became known as the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) in 1966.
In the late 1980s, because of escalating costs, paperwork demands, and general beneficiary dissatisfaction, DoD initiated a series of demonstration projects. Under a program known as the CHAMPUS Reform Initiative (CRI), a contractor provided both health care and administrative-related services, including claims processing. The CRI project was one of the first to introduce managed care features to the CHAMPUS program. Beneficiaries under CRI were offered three choices — a health maintenance organization-like option called CHAMPUS Prime that required enrollment and offered enhanced benefits and low-cost shares, a preferred provider organization-like option called CHAMPUS Extra that required use of network providers in exchange for lower cost shares, and the standard CHAMPUS option that continued the freedom of choice in selecting providers but required higher cost shares and deductibles.
Although DOD’s initial intent under CRI was to award three competitively bid contracts covering six states, only one bid, made by Foundation Health Corporation (now Health Net
Health Net
Health Net, Inc. is among the United States of America's largest publicly traded health insurers. The company’s HMO, POS, insured PPO and government contracts subsidiaries provide health benefits to approximately 6.6 million individuals in all 50 states and the District of Columbia through group,...
) covering California
California
California is a state located on the West Coast of the United States. It is by far the most populous U.S. state, and the third-largest by land area...
and Hawaii
Hawaii
Hawaii is the newest of the 50 U.S. states , and is the only U.S. state made up entirely of islands. It is the northernmost island group in Polynesia, occupying most of an archipelago in the central Pacific Ocean, southwest of the continental United States, southeast of Japan, and northeast of...
, was received. Foundation delivered services under this contract between August 1988 and January 1994.
In late 1993, in response to requirements in the DOD Appropriation Act for Fiscal Year 1994, the DoD announced plans for implementing a nationwide managed care program for the MHS that would be completely implemented by May 1997. Under this program, known as TRICARE, the United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
was divided into 12 health care regions. An administrative organization, the lead agent, was designated for each region and coordinated the health care needs of all military treatment facilities in the region. Under TRICARE, seven managed care support contracts were awarded covering DOD’s 12 health care regions.
Since then, TRICARE has undergone several restructuring initiatives, including re-alignment of contract regions, Base Realignment and Closure
Base Realignment and Closure
Base Realignment and Closure is a process of the United States federal government directed at the administration and operation of the Armed Forces, used by the United States Department of Defense and Congress to close excess military installations and realign the total asset inventory to reduce...
, and the addition of "TRICARE for Life" benefits in 2001 for those who are Medicare
Medicare (United States)
Medicare is a social insurance program administered by the United States government, providing health insurance coverage to people who are aged 65 and over; to those who are under 65 and are permanently physically disabled or who have a congenital physical disability; or to those who meet other...
-eligible, and "TRICARE Reserve Select" in 2005.
TRICARE Standard
TRICARE Standard provides a similar benefit to the original CHAMPUS program and is available to active duty personnel, retirees from the Active Component, retirees from the Reserve Component age 60 or older, and their eligible family members. Under TRICARE Standard, beneficiaries can use any civilian health care providerHealth care provider
A health care provider is an individual or an institution that provides preventive, curative, promotional or rehabilitative health care services in a systematic way to individuals, families or communities....
that is payable under TRICARE regulations. The beneficiary is responsible for payment of an annual deductible
Deductible
In an insurance policy, the deductible is the amount of expenses that must be paid out of pocket before an insurer will pay any expenses. It is normally quoted as a fixed quantity and is a part of most policies covering losses to the policy holder. The deductible must be paid by the insured,...
and coinsurance
Coinsurance
Co-insurance is an insurance-related term that describes a splitting or spreading of risk among multiple parties.-In the United States:In the US insurance market, coinsurance is the joint assumption of risk between the insurer and the insured...
, and may be responsible for certain other out-of-pocket expenses
Out-of-pocket expenses
Out-of-pocket expenses are direct outlays of cash which may or may not be later reimbursed.In operating a vehicle, gasoline, parking fees and tolls are considered out-of-pocket expenses for the trip...
. There is no enrollment fee for TRICARE Standard.
TRICARE Extra
TRICARE Standard beneficiaries can elect to use the TRICARE Extra option by using a civilian health care provider from within the regional contractor's provider network. In this way, TRICARE Extra represents a preferred provider organizationPreferred provider organization
In health insurance in the United States, a preferred provider organization is a managed care organization of medical doctors, hospitals, and other health care providers who have covenanted with an insurer or a third-party administrator to provide health care at reduced...
(PPO). When using TRICARE Extra, the beneficiary's coinsurance amount is reduced by at least five percentage points. There is no fee for use of the TRICARE Extra benefit other than the coinsurance.
TRICARE Prime
TRICARE Prime is a health maintenance organizationHealth maintenance organization
A health maintenance organization is an organization that provides managed care for health insurance contracts in the United States as a liaison with health care providers...
(HMO) style plan available to active duty personnel, retirees from the Active Component, retirees from the Reserve Component age 60 or older, and their eligible family members. Under TRICARE Prime, beneficiaries must choose a primary care physician
Primary care physician
A primary care physician, or PCP, is a physician/medical doctor who provides both the first contact for a person with an undiagnosed health concern as well as continuing care of varied medical conditions, not limited by cause, organ system, or diagnosis....
and obtain referrals and authorizations for specialty care. In return for these restrictions, beneficiaries are responsible only for small copayment
Copayment
In the United States, the copayment or copay is a payment defined in the insurance policy and paid by the insured person each time a medical service is accessed. It is technically a form of coinsurance, but is defined differently in health insurance where a coinsurance is a percentage payment after...
s for each visit. There is an annual enrollment fee for TRICARE Prime for military retirees and their family members. There is no enrollment fee for active duty military and their family members.
US Family Health Plan
US Family Health PlanUS Family Health Plan
The US Family Health Plan is a U.S. Department of Defense-sponsored healthcare plan that serves military family members exclusively. Current regional coverage includes: northeastern United States, southeast Texas and southwest Louisiana, and the Puget Sound area of Washington...
, a TRICARE Prime-sponsored health plan option, is made available by nonprofit health care providers in the Northeast U.S., Southeast Texas/Southwest Louisiana, and the Puget Sound region of Washington state.
TRICARE Reserve Select [TRS]
TRICARE Reserve Select is a premium-based health plan that active status qualified National Guard and Reserve members may purchase. The classification is sometimes referred to as TRICARE Reserve Component (RC). It requires a monthly premium and offers coverage similar to TRICARE Standard and Extra for the military member and eligible family members. It has a partial premium cost sharing arrangement with DoD similar to civilian private or public sector employer plans, although typically at a lower cost than civilian plans. The program coverage is available world wide to Selected Reserve (SELRES) members of both the Title 10 USC Federal Reserve Components (Army ReserveUnited States Army Reserve
The United States Army Reserve is the federal reserve force of the United States Army. Together, the Army Reserve and the Army National Guard constitute the reserve components of the United States Army....
, Navy Reserve
United States Navy Reserve
The United States Navy Reserve, until 2005 known as the United States Naval Reserve, is the Reserve Component of the United States Navy...
, Air Force Reserve
Air Force Reserve Command
The Air Force Reserve Command is a major command of the U.S. Air Force with its headquarters at Robins AFB, Georgia.It stood up as a major command of the Air Force on 17 February 1997....
, Marine Corps Reserve
United States Marine Corps Reserve
The Marine Forces Reserve is the reserve force of the United States Marine Corps. It is the largest command in the U.S...
), Title 14 USC Federal Reserve Component (Coast Guard Reserve
United States Coast Guard Reserve
The United States Coast Guard Reserve is the reserve component of the United States Coast Guard. It is organized, trained, administered, and supplied under the direction of the Commandant of the Coast Guard through the Director of Reserve and Leadership....
) and the Title 32 National Guard (Army National Guard
Army National Guard
Established under Title 10 and Title 32 of the U.S. Code, the Army National Guard is part of the National Guard and is divided up into subordinate units stationed in each of the 50 states, three territories and the District of Columbia operating under their respective governors...
and Air National Guard
Air National Guard
The Air National Guard , often referred to as the Air Guard, is the air force militia organized by each of the fifty U.S. states, the commonwealth of Puerto Rico, the territories of Guam and the U.S. Virgin Islands, and the District of Columbia of the United States. Established under Title 10 and...
) in a drill pay (also known as "paid") status. As of February 2008, retired Reserve Component personnel under the age of 60, actively drilling Individual Ready Reserve
Individual Ready Reserve
The Individual Ready Reserve is a category of the Ready Reserve of the Reserve Component of the Armed Forces of the United States composed of former active duty or reserve military personnel, and is authorized under...
(IRR) personnel in a non-paid status, or actively drilling Volunteer Training Unit (VTU) personnel in a non-paid status do not qualify for TRS. IRR and VTU members are eligible for reinstatement under TRS is they return to a SELRES status. Reserve Component personnel who are also Federal civil servants (to include Army Reserve Technicians and Air Reserve Technicians (ART) in the Army Reserve, Army National Guard, Air Force Reserve and Air National Guard) and eligible for the Federal Employee Health Benefit Program (FEHBP) are also excluded from TRS. Retired Reserve Component personnel and eligible dependent family members become eligible TRICARE Standard, TRICARE Extra or TRICARE Prime on the service member's 60th birthday in the same manner as Active Component retirees and their eligible dependensts are eligible immediately upon retirement from active service. Qualification questions should be referred to TRICARE.
TRICARE Reserve Retired [TRR]
TRICARE Reserve Retired is a premium-based health plan that qualified retired members of the National Guard and Reserve under the age of 60 may purchase for themselves and eligible family members. Established in 2008 and opened for enrollment in 2010, it is similar to TRICARE Reserve Select (TRS), but differs in that there is no premium cost-sharing with DoD as there is with TRS. As such, retired Reserve Component members who elect to purchase TRR must pay the full cost (100%) of the calculated premium plus an additional administrative fee. Although open to all eligible retired Reserve Component personnel under the age of 60, the program's principal focus is often perceived as being focused on recent Reserve Component retirees who are self-employed or otherwise ineligible for civilian employer provided/subsidized health insurance, especially those who were mobilized for full-time active duty service subsequent to 11 September 2001 in support of Operations ENDURING FREEDOM, IRAQI FREEDOM, NEW DAWN and/or NOBLE EAGLE. Retired Reserve Component personnel who elect to participate in TRR will exit TRR when the service member reaches age 60 and he/she and their eligible dependent family members become eligible for the same TRICARE Standard, TRICARE Extra or TRICARE Prime options as Active Component retirees and, in the case of TRICARE Prime, at the same cost as Active Component retirees. Qualification questions should be referred to TRICARE.TRICARE For Life [TFL]
TRICARE for Life was first incorporated as part of the then 7 regional Managed Care Support Contracts of TRICARE in May 2001. The benefit was enacted by Congress in response to growing complaints from beneficiaries that as Medicare out of pocket costs increased a benefit was needed to pay these costs in lieu of TRICARE retirees being required to purchase Medicare Supplemental Coverage to pay for prescriptions, physician and hospital dispensed drugs, cost shares and deductibles. Before TRICARE for Life, TRICARE beneficiaries immediately lost TRICARE coverage upon attaining Medicare eiligibility. This included becoming Medicare eligible due to disability. TRICARE for Life is designed to pay patient liability after Medicare payments. There is no enrollment necessary for TRICARE for Life and to be eligible, you must be TRICARE and Medicare Eligible and have purchased Medicare Part B coverage. An exception to the requirement for Part B coverage exists when the beneficiary that is Medicare eligible is the spouse of an Active Duty Service Member. In some instances TRICARE for Life is primary payer when the services are normally a TRICARE benefit but not covered by Medicare. This includes drug charges, when Medicare benefit limits are attained and services performed outside the United States or in a Veterans AffairsUnited States Department of Veterans Affairs
The United States Department of Veterans Affairs is a government-run military veteran benefit system with Cabinet-level status. It is the United States government’s second largest department, after the United States Department of Defense...
facility where Medicare does not pay. TFL does not pay patient liability for services that are not a TRICARE benefit even though they may be paid by Medicare, such as chiropractic benefits. The policy limitations applying to TRICARE also apply to TFL and must therefore be deemed medically necessary and skilled care. Custodial care therefore is not covered. In 2004 the TRICARE for Life benefit was transferred from the individual regional TRICARE contractors. Medical claims are processed by the national TRICARE Dual Eligible Fiscal Intermediary Contractor (TDEFIC-Wisconsin Physicians Service Insurance Corporation). Pharmacy claims are processed by the TRICARE Pharmacy Contractor (Express Scripts) and Overseas TFL claims are processed by the TRICARE Overseas Program Contractor (as of September 2010 this will be International SOS using Wisconsin Physicians Service as their Fiscal Intermediary partner).
TRICARE Young Adult [TYA]
TRICARE Young Adult (TYA) is a premium-based health care plan available for purchase by qualified dependents who have aged out of TRICARE at age 21, or age 23 for full-time college students. Dependents are eligible if they are unmarried, not eligible for TRICARE coverage or their own employer-sponsored health care coverage, and as long as their sponsor remains TRICARE eligible.Eligible dependents have the option to purchase TRICARE Standard/Extra health coverage on a month-to-month basis. Purchased coverage includes medical and pharmacy benefits but does not include dental. A premium-based TRICARE Prime benefit will be available later in 2011.
The signing of the National Defense Authorization Act in January 2011 aligned TRICARE with the provisions of the 2010 Patient Protection and Affordable Care Act, and lead to the creation of TYA.New TRICARE Program Offers Coverage for Young Adults Under 26
Enrollment began May 1, 2011.
Program administration
The ultimate responsible organization for administration of TRICARE is the U.S. Department of Defense Military Health System, which organized the TRICARE Management Activity (TMA). The TRICARE Management Activity contracts with several large health insurance corporations to provide claims processing, customer service and other administrative functions to the TRICARE program. Currently, there are three regional Managed Care Support Contractors (MCSCs), a Medicare/TRICARE Dual Eligible Fiscal Intermediary Contractor (TDEFIC), and a TRICARE Pharmacy contractor, who administers both Mail Order Pharmacy (TMOP) and Retail Pharmacy (TRRx) programs. In addition several administrative contractors provide quality management, auditing, and statistical services. TMA also oversees the TRICARE Dental Program (TDP), run by United ConcordiaUnited Concordia Companies, Inc.
United Concordia is a dental insurance company headquartered in Harrisburg, Pennsylvania, United States. It is one of the largest dental insurers in the United States. The company currently insures more than 8 million members worldwide...
, and TRICARE Retiree Dental Program (TRDP), run by Delta Dental
Delta Dental
Delta Dental is the largest dental plan system in the United States. The Delta Dental Plans Association comprises 39 independent Delta Dental member companies operating in all 50 states, the District of Columbia and Puerto Rico. These member companies provide coverage to 50 million people,...
.
Regional contractors
In 2004, TRICARE Management Activity re-aligned the previous twelve regions into three large regions, known as TRICARE NorthNorthern United States
Northern United States, also sometimes the North, may refer to:* A particular grouping of states or regions of the United States of America. The United States Census Bureau divides some of the northernmost United States into the Midwest Region and the Northeast Region...
, TRICARE South
Southern United States
The Southern United States—commonly referred to as the American South, Dixie, or simply the South—constitutes a large distinctive area in the southeastern and south-central United States...
, and TRICARE West
Western United States
.The Western United States, commonly referred to as the American West or simply "the West," traditionally refers to the region comprising the westernmost states of the United States. Because the U.S. expanded westward after its founding, the meaning of the West has evolved over time...
. Services in these regions are provided by:
- North - Health Net Federal Services, LLCHealth NetHealth Net, Inc. is among the United States of America's largest publicly traded health insurers. The company’s HMO, POS, insured PPO and government contracts subsidiaries provide health benefits to approximately 6.6 million individuals in all 50 states and the District of Columbia through group,...
The North Region includes Connecticut, Delaware, the District of Columbia, Illinois, Indiana, Kentucky, Maine, Maryland, Massachusetts, Michigan, New Hampshire, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, Vermont, Virginia, West Virginia, Wisconsin and portions of Iowa (Rock Island Arsenal area), Missouri (St. Louis area) and Tennessee (Ft. Campbell area).
- South - Humana Military Healthcare Services, Inc. The South Region includes Alabama, Arkansas, Florida, Georgia, Louisiana, Mississippi, Oklahoma, South Carolina, Tennessee (excluding the Ft. Campbell area) and Texas (excluding the El Paso area).
- West - TriWest Healthcare AllianceTriWest Healthcare AllianceTriWest Healthcare Alliance is a Phoenix, Arizona based corporation with a single line of business providing health benefits under the United States Department of Defense TRICARE program in the 21-state TRICARE West Region.-History:...
The West Region includes Alaska, Arizona, California, Colorado, Hawaii, Idaho, Iowa (excluding Rock Island Arsenal area), Kansas, Minnesota, Missouri (except the St. Louis area), Montana, Nebraska, Nevada, New Mexico, North Dakota, Oregon, South Dakota, Texas (the southwestern corner, including El Paso), Utah, Washington and Wyoming.
All medical claims are processed by the following claims processing sub-contractors:
- North and South - PGBA, LLC (a subsidiary of Blue Cross-Blue Shield of South Carolina)
- West and overseas claims - Wisconsin Physicians ServiceWisconsin Physicians ServiceWisconsin Physicians Service Insurance Corporation is a not for profit service insurance corporation based in Madison, Wisconsin. WPS offers commercial health insurance products in the state of Wisconsin and provides insurance claims processing services under various U.S. Government contracts...
Insurance Corporation
In 2009, the TRICARE Overseas Program contract consolidated the following:
- Overseas enrollment
- TRICARE Overseas claims processing
- Three area TRICARE Service Center contracts
- TRICARE Global Remote Overseas (TGRO)
- TRICARE Puerto Rico Prime
National contractors
- TRICARE Dual Eligible Fiscal Intermediary Contract (TDEFIC) - Wisconsin Physicians Service Insurance Corporation (WPS)
- TRICARE Pharmacy Program (TPharm) - Express Scripts, Inc.
- TRICARE Dental Program (TDP) - United Concordia Companies, Inc.United Concordia Companies, Inc.United Concordia is a dental insurance company headquartered in Harrisburg, Pennsylvania, United States. It is one of the largest dental insurers in the United States. The company currently insures more than 8 million members worldwide...
See also
- Military Health SystemMilitary Health SystemThe Military Health System is the enterprise within the United States Department of Defense responsible for providing health care to active duty and retired U.S. Military personnel and their dependents...
- Assistant Secretary of Defense for Health AffairsAssistant Secretary of Defense for Health AffairsThe Assistant Secretary of Defense for Health Affairs is chartered under United States Department of Defense Directive 5136.1 in 1994. This DoDD states that the ASD is the principal advisor to the U.S...
- Extended Care Health OptionExtended Care Health OptionThe Extended Care Health Option or ECHO is a supplemental coverage program offered by TRICARE to dependents of members of the Uniformed services of the United States with a qualifying disability.-Eligibility:...
(ECHO Program) - Health insurance in the United StatesHealth insurance in the United StatesThe term health insurance is commonly used in the United States to describe any program that helps pay for medical expenses, whether through privately purchased insurance, social insurance or a non-insurance social welfare program funded by the government...
- US Family Health PlanUS Family Health PlanThe US Family Health Plan is a U.S. Department of Defense-sponsored healthcare plan that serves military family members exclusively. Current regional coverage includes: northeastern United States, southeast Texas and southwest Louisiana, and the Puget Sound area of Washington...